The effect of first-wave COVID-19 restrictions on HCV testing in Alberta, Canada: A trend analysis from 2019 to 2022

Abstract

Background: Prior to the COVID-19 pandemic, Alberta was on track to meet national HCV elimination targets by 2030. However, it is unclear how the pandemic has affected progress. Here, we aim to assess the impact of first-wave COVID-19 restrictions on Alberta HCV testing trends.

Methods: HCV testing information was extracted from the provincial public health laboratory from 2019 to 2022. HCV antibody and RNA testing were categorized into (1) number ordered, (2) number positive, and (3) percent positivity, and stratified by HCV history status. Testing trends were evaluated across locations engaging high-risk individuals and priority demographics. An interrupted time-series analysis was used to identify average monthly testing rates before, during, and after first-wave COVID-19 restrictions.

Results: Overall, HCV testing trends were significantly affected by COVID-19 restrictions in April 2020. Average monthly rates decreased by 98.39 antibody tests ordered per 100,000 among individuals without an HCV history and by 1.78 RNA tests ordered per 100,000 among those with an HCV history. While antibody and RNA testing trends started to rebound in the follow-up period relative to pre-restriction period, testing levels in the follow-up period remained below pre-restriction levels for all groups, except for addiction/recovery centres and emergency room/acute care facilities, which increased.

Conclusions: If rates are to return to pre-restriction levels and elimination goals are to be met, more work is needed to engage individuals in HCV testing. As antibody testing rates are rebounding, reengaging those with a history of HCV for viral load monitoring and treatment should be prioritized.

Keywords: COVID-19; hepatitis C virus; interrupted time-series; priority populations; rates; testing; trends.

Figure 1:

Trends in monthly HCV testing levels for individuals without a history of antibody positivity (IWHAB) across Alberta from Jan 1, 2019 to Dec 31, 2022, prenatal HCV tests excluded. Blue: period before COVID-19 restrictions (January 2019–March 2020); red: implementation of first-wave COVID-19 restrictions (April 2020); yellow: follow-up period after first-wave COVID-19 restrictions were introduced (May 2020–December 2022). --···--···-- denotes month of HCV reflex testing implementation (December 2019); -------- denotes universal prenatal HCV screening implementation (March 2020)

Figure 2:

Trends in monthly HCV testing levels for individuals with a history of antibody positivity (IHAB) across Alberta from Jan 1, 2019 to Dec 31, 2022, prenatal HCV tests excluded. Blue: period before COVID-19 restrictions (January 2019–March 2020); red: implementation of first-wave COVID-19 restrictions (April 2020); yellow: follow-up period after first-wave COVID-19 restrictions were introduced (May 2020–December 2022). --···--···-- denotes month of HCV reflex testing implementation (December 2019); -------- denotes universal prenatal HCV screening implementation (March 2020)